Will COWS Soon Be Extinct?

A tour through most hospitals in the US will find the halls and patient rooms filled with COWs (Computers on Wheels) or as they are also known WOWs (Workstations on Wheels). These over-priced computer stations were the backbone of first-generation hospital EMR systems but are rapidly giving way to mobile devices like tablets as EMR systems catch up with the times.

COWS are not only expensive but they also present a number of issues in the hospital environment:

• They are difficult if not impossible to keep sterile with many nooks and crannies and complex surfaces that require sterilization. As one Infection Control Nurse recently commented, ‘there is simply no way to keep them all sterilized’.
• They need constant management. Just keeping them charged up can be a real challenge in a busy hospital. If they are not permanently parked in a patient room and kept plugged in, someone has to make sure they are on a regular charging cycle.
• They need a separate scanner to be able to scan patient wristbands, medications and consumables. Adding another device creates yet one more thing to sterilize and maintain.
• With no camera on board, they are not able to perform such basic tasks as taking a photo of a wound, documenting progression of a treatment or condition.
• They take up floor space and present opportunities for tripping. In hospitals designed before COWs were invented, there is often less than adequate space for them.

Replacing the use of COWs in cutting-edge EMR systems are mobile devices like tablets and cell phones. Mobile user interfaces using electronic clinical documents reduce the amount of keyboarding and data entry required and rely more on a variety of customized menu selections, which obviates the need for a keyboard in most cases. This has the added advantage of storing clinical data in a structured format that can be reported on instead of as free text, which has to be read to develop reporting. Mobile devices have a number of other advantages as well:

• They are very easy to sterilize. With only two surfaces, regular wiping with a sterilizer will keep them from spreading disease.
• The built-in camera can read bar codes for medications, patient identification, charging of consumables, documenting the use of medical equipment, and more.
• The camera is also very useful for taking photos of patient conditions, documents and progression of surgical wound recovery.
• Mobile devices can connect to patient data through the cell network if the hospital network is down.
• For physicians, mobile devices can connect outside of the hospital either through WIFI or the cell network. This gives physicians a lot of flexibility in monitoring hospitalized patients.
• Mobile devices can be used with speech recognition to enhance data capture. They can also be used with Blue Tooth devices like keyboards to enhance user interaction.
• They are very inexpensive. At $80 apiece, a hospital can buy 100 for less than the price of one COW.
• They take up no floor space and only a little space for a charging station.

And best of all, clinical documentation on mobile devices can be customized to the hospital’s needs and be much more efficient than paper or desktop forms. As one physical therapist recently said, ‘With the tablet, I can complete my documentation in about half the time it would otherwise take.’

Check out this video to see how mobile devices can enhance the clinical environment.